Coast Guard/Public Health Service Consultant Report
05/01/2017

Coast Guard/PHS Consultant’s Report

James D. Warner, MD, FS
Sector Houston
jwarnere@yahoo.com

Public Health Service (PHS) officers, Coast Guard (CG) medical officers, and Family Medicine friends, greetings from Seattle, Washington! As I stepped out of my taxi I knew I was in the Pacific Northwest and ready for another great USAFP Conference. As a new PHS Director I am grateful to the USAFP staff, the leadership body of USAFP, and my fellow family physicians, for another excellent annual meeting. Thank you to everyone who helped make the 2017 USAFP Annual Conference another successful event.

PHS CONFERENCE PERSPECTIVE

Compared to our fellow Uniformed Services, the PHS corps is infinitely smaller, with approximately 6700 active duty officers. Of those 6700, less than 900 are physicians and of those 900 physicians, less than 60 are CG physicians. The mission of the PHS is to protect, promote, and advance the health and safety of our nation, and encompasses over 23 different federal agencies spread all over the world. Considering the multitude of agencies our doctors are assigned to, the USAFP annual conference offers an opportunity for PHS family physicians  separated by governmental agencies, geography, and command structures, to come together and share diverse experiences. Not only does this conference allow us to see familiar PHS faces, it connects those with prior military experience with old friends from prior services and forges new ones within our sister services’.

I enjoy returning to the USAFP annual conference to share in other’s new stories. This year, I caught up with my former residency director Captain Jeff Quinlan, MD, FAAFP, USN. He is currently the Chair of Family Medicine at my alma mater, the Uniformed Services University of the Health Sciences (USUHS). It was great to hear of his successes and advancements in the Navy since his time as my mentor over ten years ago. What’s great about USAFP is our quality physicians, many of whom return year after year, such as Retired PHS Admiral Dawn Wylie, MD, who previously served as the Chief Medical Officer of the Indian Health Service Bemidji Area. It was great to see Retired Admiral Wylie offering mentorship to fellow PHS officers. LCDR Mathew Daab, MD, PHS/Indian Health Service, fellow USUHS graduate and Naval Hospital Jacksonville Family Medicine program graduate, attended this year and this allowed us to share experiences from medical school, residency, and Indian Health Service. While we are separated by years in graduation and training (and yes, I am the old guy), we are joined by our uniform, our training, our profession, and our organization. These opportunities and relationships help develop officer-ship and enhance Esprit de Corps.

Familiar faces of colleagues are important, but likewise are the familiar faces of the presenters who return to the USAFP annual conference to share their knowledge to enhance our skill sets. Not only are the most recent up to date medical guidelines important to learn and review, but I always enjoy the interesting history lessons, philosophical debates, and ethical considerations raised by presenters such as William Sykora, MD. While I have never considered myself to be like the Greek god Apollo, Dr. Sykora’s lectures are always informative and never dull. His presentation on medical oaths reminded me of the Hippocratic Oath and what it means. It is always interesting to see field grade officers rushing to presentations (as if they are late to their first period high school class) trying to make sure they get a good seat to listen to presenters such as Brian Reamy, MD, FAAFP, USUHS Senior Associate Dean of Academic Affairs. Dr. Reamy always draws a large crowd, and this year’s “Cardiovascular Disease Prevention: 2017 Update” was no different. Not only does attending the USAFP Annual Conference remind me of what it means to be an excellent physician, but also what I need to “re-learn” in some areas. I no longer practice inpatient medicine, therefore, I always attend the Inpatient Medicine Symposiums by Mike Braun, DO, FAAFP, to remind myself how smart he is and how thankful I am that family physicians like him represent us.

This year, USAFP presented us with the Annual Meeting & Exposition App for use during this year’s conference. I felt it was very helpful and informative, allowing for following the conference agenda, tracking personal schedules, and giving feedback to the lectures. It could also be used to track CME, find attendees, speakers, and exhibitors, and served as a map of the conference area and link to things to do in Seattle. Access to the app on my phone kept me in touch with daily messages from the USAFP and gave me the ability to quickly access the daily schedule, with lecture locations, just in case I wished to change my lecture schedule.

PHS MANNING

Just as civilian health care is facing a primary care shortage, the PHS and CG are as well. The most impacted agency by this shortage has been the Indian Health Service, currently with over 168 positions needing to be filled. Of those positions 102 are Family Physician qualified billets per the Indian Health Service (IHS) website at https://www.ihs.gov/index.cfm. Unfortunately, the IHS has been forced to close clinics due to lack of medical officer support. The CG has also been impacted with several open billets ranging from Washington, Oregon, California, to Washington DC, Virginia, and Puerto Rico, forcing USCG medical officers to cross cover multiple clinics that have medical officer gaps. The PHS Physician Professional Advisory Committee (PPAC) has a specific Billet subcommittee, chaired by CDR Tobe Propst and LCDR Kenneth Luna, who publish a monthly Medical Officer Job Opportunity listserv via email that provides updates to PHS physicians about job openings across the multiple PHS agencies. You can also log onto the PHS PPAC website and search under “Available Jobs” at https://dcp.psc.gov/osg/physician/. I encourage all PHS physicians to join PPAC and attend the next PPAC Forum Wednesday, May 17, 2017, see details on the PPAC website!

PHS SPECIAL PAY

PHS medical officers are currently facing the new consolidated special pay policy to be implemented by January of 2018. To adhere to the DOD specialty pay schedule, PHS officers are currently not aligned to the DOD medical pay schedule. While it is similar, there are various specialty pays that differ. The Compensation Policy Advisory Board currently meets 2-3 times per month and is providing recommendations to the Office of the Surgeon General (OSG). In addition to special pay salaries, the new policy to be implanted in January has language that may require a change in the requirement for mandatory clinical hours for doctors to maintain their specialty pay.

There was a policy change in 2008 that suspended this requirement for clinical hours to maintain retention of doctors in non-clinical billets. Currently the PPAC is working with the OSG for submitting concerns of medical officers and it is most likely that current officers will not see a loss in pay. With the changes still in limbo for another year we are currently still unsure how this will affect future PHS doctors not currently in a multi-year retention bonus or other agency contract.

PHS POLICY UPDATES

As of December 5, 2016, the OSG and the Division of Commissioned Corps Personnel and Readiness have extended maternity leave from 42 days to 84 days, following suite with our sister services. The updated policy is available on the Commissioned Corps of the US Public Health Service Management Information System (CCMIS), policy CCI 363.01, and FAQs are also addressed. Currently there are no changes to paternity leave. Changes to paternity leave policy will require legislative changes and this is being reviewed by the OSG.

PHS PROMOTION

For 2016 PHS Promotion Statistics, there were 83 eligible O-4 officers and 24 were promoted, giving a 28.9% promotion rate from O-4 to O-5 in the medical category. For 2016, there were 80 O-5 officers eligible for promotion and 23 were promoted, giving a 28.8% promotion rate from O-5 to O-6. First of all, congratulations to all officers promoted this last promotion cycle! For those medical officers not promoted, I encourage you get involved with PPAC and join the Mentoring and Career Development subcommittee, led by CDRs Joe Simon and Tobe Propst. There is also promotion and career counseling available for officers scoring in the lowest quartile on promotion boards each cycle. In addition, the subcommittee publishes a list of longterm mentor volunteers, CV examples of recently promoted officers, and offering assistance for reviewing your electronic Official Personnel Folder (eOPF).

USCG/PHS BREAKOUT

Rear Admiral Erica Schwartz, MD, JD, MPH, Director of Health, Safety, & Work-Life (HSWL) of the CG, was in attendance at this year’s USAFP Annual Conference to discuss the direction of HSWL and our impact on the CG as medical officers attached to the Department of Homeland Security. It is clear that the CG faces upcoming challenges regarding their electronic health record, medical officer manning in medical clinics, and the proposed 1.3 billion dollar budget cuts to the CG expected under the president’s new budget proposal. In addition to the challenges of daily operations, the following topics were reviewed: transgender policy, the medical board process, Disability Benefits Questionnaires (DBQs), PHS medical officer retention in the CG, and a break out session with USCG legal. What is important to take away from the admiral’s message is the importance of PHS physicians, our roles as leaders within the CG and our value to the multiple CG commands that we support, as well as  identification of current and future CG obstacles. Rear Admiral Schwartz is leading the hard charge to a positive HSWL future and ensuring full transparency to those under her command. I would like to personally thank Rear Admiral Schwartz for spending her valuable time with us, hearing our concerns about the CG direction, and taking our suggestions with such a positive experience during this year’s breakout session.

LASTLY

I salute all of my fellow PHS physicians and uniformed family medicine physicians! I would like to personally thank all those who supported my nomination to the USAFP Board of Directors as the PHS Director. I always enjoy returning to the USAFP Annual Conference to catch up with old friends, meet new ones, and improve my family medicine tool box. I look forward to seeing everyone next year in Jacksonville, FL!